Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Severe Hypoglycemia in Black & White Adults with T2D

Diabetes Care; ePub 2017 Sep 19; Lee, et al

In black and white adults with type 2 diabetes (T2D), poor glycemic control, glycemic variability, kidney damage, and measure of cognitive and functional impairments were strongly associated with increased risk of severe hypoglycemia. This according to the Atherosclerosis Risk in Communities (ARIC) Study that included 1,206 participants (mean age 64 years, 32% black, 54% female) with diagnosed diabetes. Researchers found:

  • Over a median follow-up of 15.2 years, there were 185 severe hypoglycemic events.
  • Key risk factors (after adjustment) included: age (per 5 years, HR, 1.24), black race (HR, 1.39), glycemic control (moderate vs good: HR, 1.78; poor vs good: HR, 2.62); macroalbuminuria (HR, 1.95), and poor cognitive function (HR, 1.57).
  • In an analysis of nontraditional risk factors, low 1,5-anhydroglucitol, difficulty with activities of daily living, and antidepressant use were positively associated with severe hypoglycemia after multivariate adjustment.


Lee AK, Lee CJ, Huang ES, Sharrett R, Coresh J, Selvin E. Risk factors for severe hypoglycemia in black and white adults with diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. [Published online ahead of print September 19, 2017]. Diabetes Care. doi:10.2337/dc17-0819.


Severe hypoglycemia is associated with both short-term adverse consequences as well as an increased risk of cardiovascular mortality over the subsequent 2-5 years.1 Typically, we think of individuals with tight control having an increased risk of hypoglycemia, and while this has been shown to be the case in some randomized studies, there is a suggestion from observational studies that poor glycemic control may be associated with hypoglycemia.2 Increasing age and poor cognitive status are not surprising risk factors for hypoglycemia. The importance of the current study is that it extends the risk of hypoglycemia to individuals with poor control of blood glucose, particularly those with a low 1,5-anhydroglucitol (Glycomark test) which indicates a high amount of glucose variability. —Neil Skolnik, MD

  1. Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: Retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909. doi:10.1136/bmj.b4909.
  2. Lipska KJ, Warton EM, Huang ES, et al. HbA1c and risk for severe hypoglycemia in type 2 diabetes: The Diabetes and Aging Study. Diabetes Care. 2013;36:3535–3542. doi:10.2337/dc13-0610.